Dr. Jenny Basran is getting tired of being Saskatchewan’s only geriatrician.

The 47-year-old completed her geriatric fellowship in Calgary in the early 2000s and came home to Saskatchewan in 2004 to care for the province’s aging population. She was Saskatchewan’s sole geriatrician at the time; that has not changed in the last 14 years.

“I’m really, really ready to give up the title,” Basran says.

Geriatricians are specialized medical doctors who complete a three-year residency program in internal medicine followed by a two-year fellowship in geriatric medicine. They are experts in treating elderly patients, who can present with a myriad of issues.

At the start of this year, 304 geriatricians were working in Canada, according to the Canadian Medical Association. Saskatchewan, Newfoundland and Prince Edward Island each had only one.

Based on Statistic Canada’s population estimates, Saskatchewan has the lowest proportion of geriatricians per 100,000 people of any of the Canadian provinces. Nationwide, the average is 0.8 geriatricians per 100,000 people. In Saskatchewan, that number is 0.1.

Thomas Hadjistavropoulos, a psychology professor and research chair in aging and health at the University of Regina, says the need for geriatricians in the country and province is “huge.”

People aged 85 and older are the fastest-growing demographic in Canada. According to data from the most recent census, that age group grew by 19 per cent between 2011 and 2016 — nearly four times the rate for the overall Canadian population, which grew by five per cent.

Across the country, 2.2 per cent of the population was 85 or older in 2016. Saskatchewan boasted the highest proportion of people in that age group, at 2.5 per cent.

There are family physicians in Saskatchewan who have earned a “care of the elderly” designation through the Canadian Medical Association, but Hadjistavropoulos says there is value to having geriatricians working in the province because of how complex it can be to treat older adults who may have many medical conditions, be on many medications, be metabolizing medications differently than younger people and be suffering from cognitive issues such as dementia.

“There’s a whole different ball game that requires a specialty expertise that unfortunately we don’t have enough of,” Hadjistavropoulos says.

“Anything is better than what we have now … For Regina to not have a geriatrician, the capital of the province, I think that’s a big problem. And I certainly don’t think that one geriatrician in Saskatoon is enough for Saskatoon, let alone the rest of the province.”

Dr. Frank Molnar, president of the Canadian Geriatrics Society, says the main reason Canada has a dearth of geriatricians is that, for years, geriatricians’ salaries were lower than those of other medical specialists. Until a few years ago, doctors who completed their training after a three-year internal medicine residency could earn more money than those who went on to do a two-year geriatric fellowship.

“We’re in major catch-up mode due to neglect for decades in terms of paying geriatricians at an equal level with other specialties,” Molnar said.

Saskatchewan is in a particularly bad position to be able to recruit geriatricians because the province does not have a geriatric fellowship program. People have to leave the province to train to be geriatricians and often end up settling down and working where they have trained, Molnar says.

He adds that it’s a tough sell to get geriatricians to work in a centre where there is only one other such specialist.

“If there’s only one geriatrician, the second and third one coming in know that they’re going to work to a point that’s really non-sustainable and unhealthy,” Molnar says. “You have to get a critical mass very quickly … Without that critical mass, it’s really hard to practice in the specialty and to attract people.”

When Basran started as a geriatrician in Saskatoon in 2004, she hoped to focus on academics. But she soon realized that wasn’t feasible.

“It wasn’t sustainable. I couldn’t put the time in to do research because there was just so much clinical work and just so much other stuff to do,” she said.

Part of the workload was related to staffing a 10-bed geriatric assessment unit in Saskatoon City Hospital, an inpatient unit that provided care and monitoring of elderly patients 24 hours a day, seven days a week. That unit was closed in 2009 because there wasn’t enough staff to keep it afloat.

“(Closing the unit) was a really tough decision, a very emotional decision, when we made it, but it just wasn’t a sustainable model,” Basran said. “We would love to be able to provide a seven-day service, but it’s too daunting. The volumes are too high for us to be able to provide the full scope of service that we need to provide.”

She said she would like the government to invest in creating a program similar to the geriatric assessment unit that would provide care to elderly patients who are not acutely ill, but who still require support. Otherwise, they end up taking beds that should be used for the acutely sick.

Because Basran is the only geriatrician in the province, she devotes much of her time and energy to teaching, with the goal of ensuring that all health care professionals who interact with older adults have the basic skills they need. She has also been involved in the so-far unsuccessful efforts to recruit more geriatricians to the province.

Dr. Haissam Haddad, head of the department of medicine for the University of Saskatchewan’s College of Medicine, said it’s been tough to attract geriatricians because so many medical centres across the country are also trying to woo them.

“The competition is very difficult because other centres are bigger centres, bigger cities, and they have a lot of resources and research infrastructure so (it’s) more appealing to the new graduate to go to a big centre,” he says.

The Saskatchewan Health Authority has an active job posting for a geriatrician on its website; it is seeking a certified geriatrician to do academic and clinical work for a salary of between $375,043 and $416,794 a year. The posting has been published in medical journals and newsletters and has been shared with program heads of medical schools across the country.

Last year Haddad said he received just two applications, both from “unacceptable” candidates from outside Canada.

Haddad said he is increasingly focusing on a proactive approach and targeting internal medicine residents in Saskatchewan who may have an interest in geriatrics. He said the health authority will offer to support residents’ out-of-province geriatrician fellowship training if they sign a return-to-service agreement. Such an initiative has been successful in bringing cardiologists and gastrointestinal specialists to Saskatchewan.

Haddad said he would like to have between six and eight geriatricians working in the province in the next five years. If he gets enough qualified applicants to fill the spots, the Saskatchewan Health Authority and College of Medicine have indicated money will be made available for the geriatricians to be hired, he said.

“Geriatrics for everyone is a priority.”

Haddad believes that by the time Saskatchewan has three or four geriatricians it will be able to develop its own geriatric fellowship program — something he says is “key” to addressing the province’s geriatrician shortage.

“To resolve this issue forever, we have to have our own program so our own trainees stay in the province,” he said.

Haddad thinks this is possible in the near future. He said he believes efforts to work with internal medicine residents in the province will pay off — and soon.

“I do believe the future is brighter than the past,” he added.

“I am really optimistic we’ll be able to recruit a couple geriatricians to Saskatoon and maybe one or two to Regina in about two to three years’ time.”

Basran hopes Haddad is right and she will soon have company, but said the health authority may need to make changes first for that to happen.

One of the first things the health authority needs to address is geriatricians’ pay, she said.

“The fee structure and remuneration at the very least has to be competitive, if not enticing. It needs to acknowledge the fact that you’re carrying a large responsibility relative to maybe a place where there are 15 to 20 geriatricians.”

She also wants the health authority to create an environment where geriatricians feel appreciated. Too often, she hears healthcare providers say they interact with elderly people all the time and so they know geriatrics, she said.

“It would be great if this was a place where geriatrics was actually perceived as a valuable addition to the system, so I don’t know how you create that, but it would be great to be able to do that.

“I think that’s where Saskatchewan maybe has a unique opportunity. We’re moving to a single health authority. Many of the leaders that have been hired are very aware of the benefits of geriatrics and I think if they can create an environment that really values and supports the care of complex patients, especially older adults, then that will excite people to come here … And if we can get it right and we can get that, then I think we can get people here.”

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